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Insurance terms 1

TermDefinition
Fraud Intentional deception or misrepresentation that could result in an unauthorized payment.
Abuse Actions inconsistent with accepted, sound medical, business, or fiscal practices.
Scope of practice Defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements.
Respondent Superior Latin for "Let the master answer" which means that employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment.
Statute of limitations A statute prescribing a period of limitation for the bringing of certain kinds of legal action.
Subpoena An order of the court that requires a witness to appear at a particular time and place to testify.
Stand-alone code CPT code that includes a complete description of the procedure or service.
Medical Malpractice insurance It is a type of liability insurance that covers physicians and other health care professionals for liability relating to claims arising from patient treatment
Medical Necessity It involves linking every procedure or service code reported on the claim to a condition code that justifies the need to perform that procedure or service.
Preauthorization Prior Approval
Remittance Advice(Remit) It is a notice sent by the insurance company that contains payment information about a claim.
Coinsurance The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
ABN Advance Beneficiary Notice
ADA Americans with Disabilities Act
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHAMPVA Civilian Health and Medical Program of Veterans Affairs
CMS Centers for Medicare and Medicaid Services
CMS 1500 Insurance claim used by non-institutional and other selected providers and suppliers to bill payers.
COBRA Consolidated Omnibus Reconciliation Act
CPT Current Procedural Terminology
DEERS Defense Enrollment Eligibility Reporting System
DME Durable Medical Equipment
DRG Diagnosis Related Group
EDI Electronic Data Interchange
Created by: mirandaag.
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